By Andrew M. Seaman
(Reuters Health) - At three years, improvement in type 2 diabetes is better after bariatric surgery than with lifestyle changes, a small new study suggests.
"One of the most important things to take away is that there is durability of remission over time," said Dr. Anita Courcoulas of the University of Pittsburgh Medical Center, who led the research.
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She and her colleagues studied 61 people, ages 25 to 55, with type 2 diabetes. About half had class 1 obesity and the rest were heavier.
Participants were randomly assigned to receive one of three treatments. One was an intensive lifestyle intervention for one year to help them lose weight with diet, exercise and behavior changes, followed by a lower-intensity lifestyle intervention involving behavioral counseling a few times a month for two years.
Alternatively, participants were assigned to one of two weight loss surgeries: either Roux-en-Y gastric bypass (RYGB), or laparoscopic adjustable gastric banding (LAGB). The surgeries were followed by the same low-intensity lifestyle intervention the non-surgery group got, for two years.
After three years, 40% in the RYGB group, 29% in the LAGB group and no one in the lifestyle intervention group had at least a partial remission of diabetes, according to a report online July 2 in JAMA Surgery.
Three people in the RYGB group and one person in the LAGB group had their diabetes resolve entirely, which did not occur for anyone in the lifestyle group.
Blood sugar control improved more in the surgery groups, too, and those groups were also more likely to no longer need medication for their diabetes.
While the new results are a from a randomized study, Courcoulas said they will still need to follow more patients at several medical centers over a longer period of time to draw definite conclusions.
The researchers are pooling their data with similar studies from across the country, she added.
"We'll be able to see what the remissions look like at five and seven years," Courcoulas said. "I think that's the next step in this field."
Dr. Osama Hamdy, who was not involved with the new study, cautioned that patients and doctors should not get overly excited about the results.
"Any study like this we need to be very cautious when reading them and read between the lines," said Hamdy, who is medical director of the Joslin Diabetes Center Obesity Clinical Program.
For example, Hamdy pointed out, only a handful of people in the surgery groups had resolution of their diabetes. What's more, he said, newer lifestyle-only interventions can be very effective.
"I'm cautious about this and people have to weigh the risks and benefits," he said.
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JAMA Surgery 2015.
